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Friday, November 8, 2013

Hard to Lose With Easy-to-Use LARC

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Leah Torres, MDFamily Planning FellowGeneral Division of Obstetrics and GynecologyThe University of UtahSchool of Medicine

It is often difficult to separate our personal selves from our role as clinicians. We are human, after all, and thus we are flawed and have biases. We work to reduce these biases through our dedication to life-long learning in order to provide objective, evidence-based health care to our patients. As more research regarding long-acting reversible contraception (LARC) methods comes to fruition, we must also adjust our views, let go of misconceptions and apply our ability to embrace new evidence-based practices. The CHOICE Project out of Washington University in St. Louis, MO continues to provide useful data guiding us in contraception provision. The analysis of CHOICE data by Dr. Grunloh et al, published in the December 2013 issue of Obstetrics & Gynecology, helps us understand different behaviors regarding use of LARC methods that we may have only guessed at previously. We see that even in adolescent and young women, the provision of LARC methods is an important aspect of providing our patients with the most advanced and high-quality means for planning their families.

We must let go of some common preconceived notions when counseling women on how to plan their families. One misconception we may have or that our patient may have is that if she does not have a male partner in the moment of her visit with us, then she does not need LARC. Some women perceive that if they are not in a “long-term” relationship then they do not need “long-acting” contraception. There are also concerns of “wasting” these devices if women discontinue them soon after placement. Regarding family planning, the bottom lines are these: women must be allowed to decide the best method for them and the most effective methods should be offered first and offered to all (barring evidence-based contraindications).

Intrauterine devices (IUDs) and implants are highly effective against unplanned pregnancy and are safe in almost every woman. Biases against nulliparous, adolescent, or non-monogamous patients should be forgotten. All women must have an equal opportunity to control their reproductive health by being offered LARC methods as first-line therapy against unplanned pregnancy. Concerns of wasting money or wasting devices out of fear of discontinuation should not enter counseling. The Grunloh study demonstrates a low discontinuation rate before 6 months and the IUDs are among the most cost-effective methods of contraception.1 We also know from the CHOICE Project that when financial barriers are removed, LARC methods are highly desired with high continuation rates and high satisfaction at 12 months.2

Providing the best care means keeping up to date with evidence-based medicine. In the realm of contraception and family planning, we should be skilled in counseling and providing the most effective methods including sterilization, IUDs, and implants. Empowering our patients to make the most informed decisions regarding their health and the health of their families is a humbling privilege. LARC methods should be first-line in counseling women regarding the most effective ways to plan their families, especially if women have decided that children will not be a part of their families. After all, planned families are the healthiest families.

References

Trussell J. Update on and correction to the cost effectiveness of contraceptives in the United States. Contraception 2012;85:218.

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Posted by William C. Dodson, MD at 1:31 PM

Tags: LARC, IUDs, family planning, CHOICE project

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About the Author

William C. Dodson, MD

William C. Dodson, MD, is Professor of Obstetrics and Gynecology and Director of the Division of Reproductive Endocrinology and Infertility at Penn State College of Medicine. He completed his fellowship in reproductive endocrinology at Duke University. His research and clinical areas of focus include treatment of infertility, especially ovulation induction. He was previously on the Editorial Board of Obstetrics & Gynecology and has served as the Consultant Web Editor for Obstetrics & Gynecology since 2008.